[Biliary elimination of metampicillin. Experimental and clinical study (author's transl)]

Under the conditions of the isolated rabbit liver perfusion, metampicillin was found to be excreted at a high rate in the biliary tract : bile contains 46,5% of the administered dose. Hepatic uptake of metampicillin seems to be early and marked. In man, the biliary elimination of this antibiotic varies according to the route of administration. Only moderate biliary levels of metampicillin were obtained after oral administration ; on the contrary, extremly high biliary concentrations were found when antibiotic was injected intravenously. When parenteraly administered, metampicillin appears to be a particularly suitable penicillin for the treatment of biliary tract infections.

Hepatic toxicity in the rhesus monkey treated with chenodeoxycholic acid for 6 months: biochemical and ultrastructural studies

The long term administration of chenodeoxycholic acid in man has to be regarded with caution because chenodeoxycholic acid has caused liver damage in various species of animals, including primates. To study the effect of three doses of chenodeoxycholic acid (10, 40, and 100 mg per kg per day) on hepatic function and morphology, biliary bile acid composition and the reversibility of changes were investigated in 22 rhesus monkeys. After 6 months of treatment with 40 and 100 mg per kg per day, bile duct proliferation, portal tract inflammation and fibrosis, bile canalicular bleb formation, and hypertrophy of the smooth endoplasmic reticulum were associated with elevated serum levels of oxaloacetic transaminase, glutamic pyruvic transaminase, and leucine aminopeptidase. In the bile, the proportion of chenodeoxycholic acid and its bacterial metabolite, lithocholic acid, rose to approximately 85 and 10% of the total bile acids. After chenodeoxycholic acid was withdrawn for 3 months, the hepatic morphological lesions persisted in some animals although biliary bile acid composition returned to normal. No hepatic abnormalities were seen in the animals treated with 10 mg per kg per day. The findings suggest that long term treatment of rhesus monkeys with high doses of chenodeoxycholic acid results in severe hepatic histological lesions that can persist after discontinuation of the bile acid.

[Mechanism of the hypobilirubinemic effect of prednisolone and some pyrazolone derivatives]

The effects of prednisolone (1 mg/kg), nicophezone (10 mg/kg), phenylbutazone 30 mg/kg) and antradion (60 mg/kg) on choleresis and bilirubin passage with bile was studied in intact and CCl4-poisoned rats (by using hemolyzed blood loads). Intravenous administration of hemolyzed blood to intact animals was shown to be attended by an increased excretion of bilirubin with the bile. When superimposed upon the CCl4 poisoning--the excretion of bilirubin diminishes. The study compounds stimulated the passage of bilirubin with the bile following introduction of hemolyzed blood both in intact animals and in the ones with the CCl4-damaged liver. The data thus made available are used in interpreting the mechanism underlying the hypobilirubinemic effect of the compounds.

Measurement of squalene in human tissues and plasma: validation and application

A method is described for accurate and reproducible measurement of squalene in plasma, feces, urine, bile, and tissue that depends on isolation by alumina column chromatography after mild saponification and on measurement by gas-liquid chromatography. Recoveries from all tissues exceeded 80% and from plasma 96%; losses were accurately corrected by appropriate additions of squalene as an overall recovery standard.

Daily fluctuation of lithogenicity in bile in the postoperative period in cholecystectomized patients

The lithogenicity of bile samples taken over 14 hrs from 7 a.m. to 9 p.m. on two consecutive days at 4-5 hrs intervals has been measured in 7 freshly colecystectomized patients on the 7th to 9th postoperative days. The values have also been estimated additionally in 4 patients 1 and 2 hrs after meal intake. It was found that the lithogenicindex is higher at 16 and 21 hrs than at 7 and 11 hrs. The lithogenicity began to increase 2 hrs after lunch. The observed difference between our results and those of other authors could be due either to the changed enterohepatic circulation before the begin of our study or to the different types of populations studied.

Gallbladder function, cholesterol stones, and bile composition

Gallbladder bile obtained at operation from five patients with no symptoms of biliary disease was undersaturated with cholesterol in every case. However, gallbladder bile from patients with stones composed of 97-100% crystalline cholesterol was on average just saturated with cholesterol when the gallbladder was functioning and undersaturated when it was not. Regardless of gallbladder function, the patients with stones had on average significantly more cholesterol in their bile than in the control group, but the differences between the mean composition of bile from functioning and non-functioning gallbladders were not significant. Common duct bile from patients with non-functioning and functioning gallbladders was on average supersaturated with cholesterol, but there was significantly more bile salt and significantly less cholesterol in the bile from patients with non-functioning gallbladders. Only in the case of patients with functioning gallbladders did the mean composition of the common duct and gallbladder biles differ significantly. The former contained significantly more cholesterol and less bile salt than the latter. It is suggested that patients with non-functioning gallbladders may be 'autocholecystectomised' with the duct bile reverting to a more 'normal' composition.

Role of bile in intestinal absorption of 203Pb in rats

The author studied absorption of 203Pb after administering intraduodenally 203Pb eliminated with bile. The results obtained were compared with absorption of 203Pb administered into the duodenum as 203PbCl2 in rats forming 2 groups, one with bile ducts cannulated, the other intact. It was found that bile played an important role in absorption of Pb from the gastrointestinal tract. Absorption of Pb203 is significantly reduced if the bile is drained off by means of a canula.

An enzymic method for the determination of the glycine/taurine ratio of conjugated bile acids in bile

A method is described in which the ratio of the glycine- to taurine-conjugated bile acids (G/T ratio) in bile is determined. After pretreatment of the bile for removal of the lipids, the bile acids are deconjugated enzymically with choloylglycine hydrolase (EC 3.5.1.24). The amino acids taurine and glycine are liberated in this way, after appropriate isolation, taurine and/or glycine are then determined with ninhydrin, enabling the establishment of the G/T ratio. A nearly complete hydrolysis was obtained for 6 conjugated bile acids, while the recovery of these acids when added to hog or ox bile was quantitative. The mean G/T ratio for hog bile, ox bile and human B-bile was 6.3, 2.5 and 2.0, respectively. The amount of total, free and conjugated bile acids can be determined by this method, combined with the 3alpha-hydroxysteroid dehydrogenase technique for bile acid determination described by Iwata and Yamasaki [1]. A high G/T ratio was observed in 3 cases of Crohn's disease in the small bowel, but the extent of deconjugation in B-bile was lower than in duodenal fluid. The determination of the G/T ratio can be complementary to our knowledge of the metabolism of bile salts in certain gastro-intestinal disorders.

Biliary lipid composition in early childhood

The biliary lipid composition was studied in 11 children without hepatic or gastrointestinal disease who ranged in age from 15 to 54 months. The molar percentages of cholesterol, bile acids and phospholipids in the biliary lipid mixture averaged 5.0 +/- 1.1; 80 +/- 6.1 and 15 +/- 6.2%, respectively. Cholic, chenodeoxycholic, deoxycholic and ursodeoxycholic acid comprised 48; 45; 4 and 3% of total bile acids, respectively. A comparison of the lipid composition with data reported in the literature for the adult reveals that the molar percentage of cholesterol is relatively low in early childhood. This could be one of the factors which is responsible for the low incidence of cholesterol gallstones in this age group.

Prostaglandin-induced choleresis in the rat

It could be demonstrated that intraportal infusion of prostaglandin A1 (1 mug/min/100 g body wt.) in Wistar rats significantly increases bile flow. An analysis of the relationship between bile salt excretion and bile flow revealed that this choleresis is due to an increase in the bile salt independent fraction of bile.

Bile reflux gastritis. Analysis of fasting and postprandial gastric aspirates

Gastric aspirates from 11 patients with bile reflux gastritis were studied for pH, bacterial cultures, proteolytic acitivity and bile salt pattern. Hypochlorhydria, significant bacterial overgrowth and unconjugated bile salts were found in all gastric specimens tested. The presence of unconjugated bile salts may account for the severity of the gastritis seen in these patients.

[Incarcerated gallbladder in cholecystitis]

Among 206 examined patients with cholecystitis and similar diseases in 112 (65%) cases, as evidenced by the authors' findings, the gallbladder proved to be non-functioning. Its escape in the biliary system was functional (indirect) or organic (absolute). The main causes of a direct organic escape of the gallbladder are as follows: destructive changes in its walls, strictures, strangulated gall stones, shrinkage or hydropsy. The reliable preoperative diagnosis of an escaped gallbladder by means of accelerated chromoduodenal catheterization, intravenous (infusion-drip) or associated (intravenous-peroral) cholecystocholangiography, correlated with the anamnesis data and clinical signs, rather speaks in favour of cholecystectomy on absolute indications.

Stratification of bile in gallbladder and gallstone formation

The essential role of the gallbladder in gallstone formation should not be underestimated, as cholesterol stones originate in the gallbladder. The possible significance of stratification of bile in the gallbladder has been studied using recently proposed lithogenic parameters, such as triangular co-ordinates, lithogenic index and cholesterol saturation index. Bile becomes less lithogenic as the concentrating process in the gallbladder progresses. The concentrating activity of the gallbladder seems to differ considerably for each bile constituent. Bile salts are most concentrated in the gallbladder, followed by phospholipids and cholesterol. The presence of a selective absorption process in the gallbladder is suggested. As the gallbladder diminishes the lithogenicity of bile during storage, its role probably lies in its ability to interrupt the enterohepatic circulation leading to the production of lithogenic bile as well as providing a recess to ensure continuous growth of stones.

Differences of reabsorption of unconjugated BSP and BSP-glutathione from the rat biliary tree after retrograde intrabiliary injection

It has been shown that water and electrolytes are reabsorbed from the biliary tract of the rat. Furthermore there are some suggestions for the reabsorption of organic compounds during their passage down the biliary tract. Our results presented in this paper demonstrate a different mode of biliary excretion of unconjugated BSP [BSP-U] and BSP- glutathione [BSP-GSH] after retrograde intrabiliary injection, BSP-GSH is excreted to a much greater extent than BSP-U within the first 5 minutes after retrograde administration. In other terms BSP-GSH is reabsorbed to a lesser extent than BSP-U. Additionally the reabsorption of BSP-U and BSP-G after retrograde injection seems to be dependent on the concentration and the contact time in the biliary tree. It is suggested that the different biliary excretion of BSP-U and BSP-GSH after intravenous injection might be explained partly by a different reabsorption mode.

Bile acid kinetics and bile secretion in the pony

Bile acid pool size and synthesis rate were determined by both isotope-dilution and washout methods in ponies with chronic external biliary fistulas. Bile acid pool size (10.9 mumol/kg) and synthesis rate (11.2 mumol/day per kg) estimated by the isotope-dilution method did not differ significantly from pool size (9.4 mumol/kg) and synthesis rate (9.5 mumol/day per kg) estimated by washout method. Bile acid-dependent and -independent fractions of bile flow, determined by a method that circumvents any inevitable correlation of flow to bile acid secretion due to common factors in both parameters, did not differ from those values obtained by linear regression of bile flow versus bile acid secretion. The choleretic effect of infused chenodeoxycholic acid was higher than that of both endogenous bile acid and infused taurocholic acid.